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World Tuberculosis Day: Confronting TB/HIV Co-Infection

This Sunday, March 24, is World Tuberculosis (TB) Day. Around the world, countries will mark the day in 1882 when Dr. Robert Koch announced his discovery of the bacterium that causes TB. Since the 1980s, this day has also served as a rallying call to raise public awareness and recommit political will toward eliminating the disease.

Today, TB is the leading cause of death among people living with HIV in sub-Saharan Africa-accounting for 1,000 lives lost each day. Given this enormous human toll, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) continues to address the deadly links between TB and HIV as a top policy and programmatic priority.

In November 2012, the Obama Administration released the PEPFAR Blueprint for Creating an AIDS-Free Generation. The Blueprint, which demonstrates in detail the United States' unwavering commitment, through PEPFAR, to helping end AIDS, outlines specific implementation steps to prevent and treat TB and HIV co-infection. The Blueprint also highlights PEPFAR's ongoing commitment to strengthen the capacity of partner countries efforts to address these dual epidemics, as they move ever closer to achieving an AIDS-free generation.

Today, while 79 percent of the total global burden of HIV-positive TB cases is found in sub-Saharan Africa, the tide of hope is rising. Through a combination of widespread antiretroviral treatment (ART), early identification and treatment of TB, isoniazid preventive therapy, and infection control activities, TB infection rates can be reduced dramatically. Ending HIV-associated TB is no longer merely aspirational, it is achievable.

To help makes this promise a reality, PEPFAR works closely with national TB and AIDS programs, multilateral institutions including the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and other partners to strengthen systems that address TB and HIV. Over the past five years, PEPFAR funding for TB/HIV collaborative activities has increased by more than eight-fold. High rates of HIV testing among TB patients are being reported in many of the countries where PEPFAR works. In 2011, 59 percent of reported TB patients in Africa had a reported HIV test, compared with less than 4 percent in 2003.

These efforts have contributed substantially to the estimated 1.3 million lives that were saved from 2005-2011 through collaborative TB/HIV interventions. Moreover, from 2009-2011, TB-related AIDS deaths in Africa declined by 15 percent compared with 10 percent over the prior four years. The pace of progress toward ending HIV-associated TB mortality is accelerating, but more work remains to reach the finish line.

PEPFAR also supports efforts to scale up the Cepheid Xpert MTB/RIF test, a new fully automated molecular diagnostic test for TB. This test enables TB/HIV programs to diagnose TB more quickly, which helps to reduce TB transmission and slow the progression of TB disease. In short, it helps save lives. In August 2012, PEPFAR and USAID partnered with UNITAID and the Bill & Melinda Gates Foundation in an innovative public-private partnership to reduce the cost of Xpert MTB/RIF cartridges by 40 percent (from $16.86 to $9.98 per cartridge). This partnership will accelerate access to this cutting-edge technology in the 145 countries eligible for this pricing.

While confronting TB and HIV remains a considerable challenge, we are collectively turning the tide of these dual epidemics. To help achieve an AIDS-free generation, PEPFAR will continue its efforts to prevent and treat TB/HIV co-infection, and to strengthen the systems and tools needed to manage both diseases. On this World TB Day, let us all recommit to saving even more lives in 2013 by keeping our focus firmly on the intersection between TB and HIV.